KUFLIK DERMATOLOGY CENTER
HIPAA PRIVACY NOTICES
Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
If you have any questions about this Notice, please contact our Privacy Officer at the website or number listed at the end of this notice.
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Our Responsibilities
Kuflik Dermatology is required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We will follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us that we can, you may change your mind at any time. Let us know in writing if you change your mind. The current notice will be posted in the waiting area and on our website at www.kuflikderm.com. The notice will include the effective date. In addition, we will make our best effort to provide you with a copy of this notice that we request you acknowledge with your signature. Kuflik Dermatology is required by law to adhere to a standard for “minimum necessary” use and disclosure of PHI. We make reasonable efforts to limit the use of, the disclosure of, and the requests for PHI to the minimum necessary to accomplish the intended purpose of any request.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site at www.kuflikderm.com.
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How Kuflik Dermatology Center May Use or Disclose Your Health Information
For Treatment–
- Kuflik Dermatology can use your health information and share it other professionals who are treating you. For example, a doctor treating you for an injury asks another doctor about your overall health condition.
For Payment–
- Kuflik Dermatology can use and share your health information to bill and receive payment for treatment and services that you receive from health plans or other entities. For example, we give information about you to your health insurance plan so it will pay for your services.
For Health Care Operations–
- Kuflik Dermatology can use and disclose your health information to run our practice, improve your care, and contact you when necessary. For example, we use health information about you to manage your treatment and services.
Business Associates–
- There are some services provided in our organization through contracts with business associates. Examples include, but are not limited to, billing collections, document destruction, and software support. If these services are contracted, we may disclose your health information to our business associate so that they may perform the job that we have asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to safeguard your protected health information through a written contract.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object
Kuflik Dermatology also may use and disclose your health information as set forth below. If you have a clear preference for how we share your information in the situations as set forth below, talk to us. Tell us what you want us to do, and we will follow your instructions. If you are not present or able to agree or object to the use or disclosure of the health information (such as in an emergency or are unconscious), then your provider may, using his/her professional judgment, determine whether the disclosure is in your best interest. In this case, only the information that is relevant to your health care will be disclosed. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care.
- Share information in a disaster relief situation
- Include your information in a hospital directory
In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again
Future communications:
- Kuflik Dermatology may communicate to you via newsletters, mailings, emails, postcards, or other means regarding treatment options, skin care tips, promotions, information on health related benefits or services; to remind you that you have an appointment for medical care, to remind you to make an appointment with our office via a postcard; or other community based initiatives or activities in which our facility is participating. If you are not interested in receiving these materials, you can advise us if you would like to opt out of any of the above.
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Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object
Kuflik Dermatology may use or disclose your health information in the following situations without your authorization or without providing you with an opportunity to object– many of these situations are required by law and such uses and disclosures are used in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: https://www.hhs.gov.
Help with public health and safety issues
- We can share health information about you for certain situations such as:
Preventing disease, Helping with product recalls; reporting adverse reactions to medications; Reporting suspected abuse, neglect, or domestic violence; Preventing or reducing a serious threat to anyone’s health or safety
Do Research
- We can use or share your information for health research
Comply with the law
- We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
- We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
- We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
- We can use or share health information about you:
For workers’ compensation claims; for law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law;
For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
- We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Your Rights
Although your health record is the physical property of Kuflik Dermatology, you have certain rights. This section explains your rights and some of our responsibilities to help you:
Get an electronic or paper copy of your medical record-
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information, usually within 30 days of your written request. In accordance with New Jersey state law, we charge for copies of medical records.
Ask us to correct your medical record-
- You can ask us in writing to correct health information about you that you think is incorrect or incomplete. You must also tell us the reason why you are making the request.
- We may say “no” to your request, but we will tell you why in writing within 60 days.
Request Confidential Communications-
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
Ask us to limit what we use or share-
- You can ask us NOT to use or share certain health information for treatment, payment, or our operations.
- We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you pay for a service or health care item out-of pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
- We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we have shared information-
- You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations and certain other disclosures (such as any you asked us to make). We will provide one accounting a year free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this Privacy Notice-
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you-
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. This request must be made in writing.
- We will make sure the person has this authority and can act for you before we take any action.
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Complaints
You may complain to Kuflik Dermatology if you believe your privacy rights have been violated. You may contact us at 732-341-0515 and ask for the Privacy Officer. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints. All complaints must be made in writing within 180 days of when you knew the violation occurred. You will not be retaliated against for filing a complaint.
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Contact Information
Kuflik Dermatology
453 Lakehurst Road
Toms River, NJ 08755
www.kuflikderm.com
Privacy Officer: Dawn M. Jackson, LPN
Email: www.djackson@kuflikderm.com
Telephone Number: 732-341-0515 ext. 139
Effective date of Privacy Notice: September 6, 2022